• Very effective with nothing to remember for up to 7 years. “Are you looking for a method that is easy to use effectively?”

• Side-effects: see page IM3.

• For STI/HIV/AIDS protection, also use condoms.

Norplant Implants• 6 small plastic tubes placed

under skin of upper arm

• Heavy women may need them removed after 4 or 5 years (see page IM4). Another set of capsules can be inserted if client wants to continue using implants.

• Can get pregnant soon after capsules are taken out.

“Would you like to know more about implants, or talk about a different method?”If client wants to know more about

implants, go to next page.

Next Move:

• Very effective

• Last up to 7 years, depending on your weight

• Very safe

• Usually change monthly bleeding• No protection against STIs or

HIV/AIDS

Implants

IM1

• Implants are not harmful for health. They do not bother her or affect strength. For breastfeeding women, they do not affect the quality of breastmilk.

• Check for concerns, rumours: “What have you heard about implants?”

• Explain common myths. Capsules do not break inside the body. They are bendable. (Also see Appendix 10.)

About Norplant implants: • Contain progestogen but not estrogen hormones. • Work mainly by thickening the cervical mucus and by stopping ovulation

(see Appendices 4 & 5). • Soft capsules that are just visible under the skin. Do not leave

noticeable scar if inserted and removed correctly. • Inserted and removed by trained personnel in simple surgical procedure.

To discuss another method, go to a new method tab or to Choosing Method tab.

But usually cannot use implants if:

Who can and cannot use implants

Most women can safely use implants

• Breastfeeding 6 weeks or less

• May be pregnant

• Some other serious health conditions

• Breastfeeding 6 weeks or less

“We can find out if Norplant implants are safe for you. Usually, women with any of these conditions should use another method.”

Who can and cannot use implants

• Ask her to come back when baby is 6 weeks old. Urge her to keep breastfeeding.

Client is unable to use implants: Help her choose another method.

Client is able to use implants:Go to next page.

Next Move:

• If in doubt, use pregnancy checklist in Appendix 1 or perform pregnancy test.

Implants

Most women can safely use implants.But usually cannot use implants if:

IM2

Usually cannot use with any of these serious health conditions (if in doubt, check handbook or refer)

• Some other serious health conditions • Has blood clot in lungs or deep in legs. Women with superficial

clots (including varicose veins) CAN use implants.• Ever had breast cancer.• Unexplained vaginal bleeding: if the bleeding suggests a serious

condition, help her choose a method without hormones to use until unusual bleeding is assessed.

• Serious liver disease or jaundice (yellow skin or eyes).• Takes pills for tuberculosis (TB), fungal infections, or seizures

(fits).

• May be pregnant

Possible side-effects

• Very common: Light spotting or bleeding

• Common: Irregular bleeding, no monthly bleeding

• Less common: Some others

How would you feel about these

side-effects?

If you choose this method, you may have some side-effects. They are not usually signs of illness.

Important to explain menstrual changes: • Expected and common.• Amenorrhoea (no monthly bleeding): Does not permanently affect fertility.

Rarely a sign of pregnancy. Explain that blood does not build up inside body.

Possible side-effects

Does client understand side-effects? Is she happy to use method?Next Move:

If so, go to next page. If not, discuss further or consider other methods.

Implants

IM3

• “It can take time for the body to adjust.”• Different people have different reactions to methods.Discuss:• “If these side-effects happened to you, what would

you think or feel about it?” • “What would it mean to you?”• “What would you do?”• Discuss any rumours or concerns. See Appendix 10 on myths.

Less common side-effects:• Headaches, lower abdominal pain, dizziness, breast tenderness, upset

stomach (nausea), nervousness.• Can take paracetamol or ibuprofen for headache.Rare side-effects:• Acne or rash, change in appetite, weight gain, hair loss or more hair on face.

• Invite client to return for help any time.• “It is okay to switch methods any time. Please come back if you want the

implants taken out.”• For dealing with side-effects, see Returning Client tab page RC 13.

• Very common: Light spotting or bleeding

• Common: ― Irregular bleeding

― No monthly bleeding

• Less common: Some others

If you choose this method, you may have some side-effects. They are not usually signs of illness.

Implant insertion and removal• Insertion and removal should be

quick and easy

• Injection prevents pain

• Provider puts 6 capsules just under the skin of inside upper arm

• Provider bandages opening in skin and wraps the arm — no stitches

• Need to be removed after 4 to 7 years, depending on your weight

Are you ready to choose this method?

What questions do you have?

Does client understand the insertion and removal procedure? Is she ready to choose method?

Implant insertion and removal• Explain that procedure will be done by a specially trained provider.• Insertion usually takes 5 to 10 minutes. • Removal usually takes about 15 minutes, sometimes longer.

• Let her feel a sample capsule.• If possible, show her a photo of capsules under skin.

• Insertion and removal are done gently.• Just one small opening in the skin. May be slight pain, swelling, bruising

for a few days. • Keep area dry for 5 days. Can remove bandage after 5 days.• “Please come back if arm stays sore for more than 5 days or if opening

becomes red or has yellow liquid.”

• Insertion and removal should be quick and easy

Next Move:

Implants

• Local anaesthetic stops pain during insertion. Woman stays awake.

IM4

When to remove or replace implants?• Norplant implants need to be removed or replaced 4 to 7 years after

insertion, depending on client's weight, as the method becomes less effective in heavier women.

– Weighs less than 70 kg: She can keep implants for up to 7 years unless her weight reaches 70 kg or more.

– Weighs 70 to 79 kg: She should come back after 5 years to have implants removed unless her weight reaches 80 kg or more.

– Weighs 80 kg or more: She should come back after 4 years to have implants removed.

• All women can have new implants or another method.

• Injection prevents pain

• Provider puts 6 capsules just under the skin of inside upper arm

• Provider bandages opening in skin and wraps the arm — no stitches

• Need to be removed after 4 to 7 years, depending on your weight

If she has decided to use method, go to next page.

If not, discuss further or consider other methods.

You may be able to start today

• You can start any day of the menstrual cycle if we can be sure you aren’t pregnant

Would you like to start now?

You may be able to start today

Client ready to start now?Next Move:

Implants

If yes, insert implants or arrange for insertion as soon as possible.

If not, arrange another visit (during next menstrual period would be best).

Give condoms to use until then. Explain their use.

• You can start any day of the menstrual cycle if we can be sure you aren’t pregnant

IM5

If menstrual bleeding started in past 7 days:• She can start NOW. No extra protection needed. If menstrual bleeding started more than 7 days ago or if amenorrhoeic (not having menstrual periods):• She can start NOW if reasonably certain she is not pregnant (use pregnancy checklist

in Appendix 1). No need to wait for next menstrual period to get implants. • She should avoid sex or use condoms for 7 days after insertion.

If switching from another method:• If switching from pills, now is the best time to start. • If switching from an injectable, should start at time she would have had repeat

injection.• If switching from IUD, and menstrual bleeding started more than 7 days ago, can get

implants now but leave IUD in place until the next menstrual period.

After childbirth, if breastfeeding:• If fully (or nearly fully) breastfeeding, can start from 6 weeks after childbirth. No extra

protection needed if she is between 6 weeks and 6 months after giving birth and her periods have not returned.

• If partially breastfeeding, best to start 6 weeks after giving birth. Waiting longer risks pregnancy.

After childbirth, if NOT breastfeeding:• Can start immediately after childbirth. If in the first 4 weeks after giving birth, no extra

protection is needed.After miscarriage or abortion:• Can start immediately after abortion. If in the first 7 days after abortion, no extra

protection is needed.

What to remember

• Come back when it is time to have the implants removed See a nurse or doctor if:

• Yellow skin or eyes

• May be pregnant, especially if pain or soreness in belly

• Unusually heavy or long bleeding

• Infection or continued pain in the insertion site

Anything else I can repeat or explain?

Any other questions?

• Side-effects are common but rarely harmful. Come back if they bother you.

• Come back any time if you have problems or want implants removed

• A bright spot in your vision before bad headaches

What to remember• Women under 70 kg: Come back in 7 years. If a woman

gains much weight, she should come back sooner.• Woman 70 to 79 kg: Come back in 5 years.• Woman 80 kg or more: Come back in 4 years.• At this time all women can have their implants replaced or

choose a new method • If possible, give client a durable card that states date of

insertion and date (with month) when she should return.

“Do you feel confident you can use this method successfully? Is there anything I can repeat or explain?” Remember to offer condoms for dual protection!

Last, most important message: “Please come back any time you have questions or want to have implants removed.”

Last Moves:

Implants

• See a nurse or doctor if:― A bright spot in your vision before bad

headaches (migraine aura)― May be pregnant, especially if pain or soreness

in belly― Infection or continued pain in the insertion site― Unusually heavy or long bleeding― Yellow skin or eyes

Return Signs:• “In many cases these signs are not related to the implants.

But a doctor or nurse needs to check if a serious problem is developing and if you can continue using implants.”

• “I want you to know about them and remember them.”

• If another health care provider asks about her medications, she should mention the implants.

IM6

• Bleeding that is more than 8 days long or twice as heavy as usual.

• Come back when it is time to have the implants removed

• Remind client that implants can be removed any time she wishes.

• Side-effects are common but rarely harmful. Come back if they bother you.

• Come back any time if you have problems or want implants removed

• Simple surgical procedure

• Permanent. For men who will not want more children.

• Very effective

• Very safe

• No effect on sexual ability

• No protection against STIs or HIV/AIDS

Vasectomy for Men

Do you want to know more about this method, or talk about

a different method?

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